Councilor Joel Alangsab, principal author of the Universal Health Care Ordinance, said there will be “no patient left behind” if and when the Universal Health Care (UHC) Act will be fully implemented in the city and in the entire country.
Alangsab stressed that, under the Act, barangay healthcare workers will be the primary care providers. This way, health care becomes more accessible to everyone, especially the poor.
Stressing the importance of having access to healthcare, he underscored that anyone from the family could be a patient. He added that the UHC Act provides everyone access to healthcare services without experiencing financial stress.
On February 20, 2019, President Rodrigo Duterte signed the UHC Act. The general objective of the Act is to ensure equitable access to quality and affordable healthcare and protection against financial risk. The UHC law also provides solutions for all the timely and relevant medical concerns.
One of the principles of this Act is to have a people-centered approach, where people’s safety, health, and access to an affordable medical experience are prioritized.
Under the Act, there will be a primary care provider team for every family, healthy living, schooling, and working environment.
The Universal Health Care Ordinance of Baguio City aims to institutionalize and localize the Act. The local legislation is meant to enhance and strengthen the implementation of the UHC Act in the city. It will tailor-fit the universal health care programs to the specific needs of the locality.
In 2019, the Department of Health (DOH) chose Baguio City as a site for the advance implementation of the UHC Act.
During a series of public consultations conducted by the Sangguniang Panlungsod through the office of Alangsab, the DOH and the Philippine Health Insurance Corporation were invited to present certain provisions of the UHC Act.
Stefanie Sereno, a department management officer of the Department of Health- Cordillera Administrative Region (DOH-CAR), said many people have been struggling to access health care due to the scarcity of healthcare workers especially in the grassroots and due to financial reasons.
According to her, the most common healthcare problems in the localities are maternal and infant diseases; low immunization rates, expensive medical bills, indigents solely paying for their healthcare bills, public hospitals being overly crowded, and scarcity in healthcare workers.
She said more people are pushed into poverty because of little to no access to healthcare.
Lovella Severo, another DOH- CAR officer, explained that our current healthcare system is fragmented and that we need to overhaul or reform it to make it more holistic and responsive to the needs of the people.
She said by 2025, the City of Baguio will have already fully implemented the UHC Act.
She emphasized that one of the major concerns in the present healthcare system is crowded hospitals, that is why under UHC Act is the Health Care Provider Network (HCPN).
The HCPN serves as a gatekeeper to a number of people in a hospital where primary care can attend to minor illnesses and be directed to Health Centers. Major conditions, on the other hand, are referred to hospitals. Also, the HCPN encourages Barangay Healthcare Workers to enhance their capabilities and knowledge in order to properly attend to the needs of their constituents.
She also highlighted the importance of the participation of the LGUs wherein they should enact healthcare legislations to help solve healthcare concerns.
Janet Palaez, Chief Social Insurance Officer of Philippine Health Insurance Corporation, was also invited to discuss Philhealth-related concerns. She explained the new regulations on health insurance under the Universal Health Care Act.
Philhealth applies the rule on Immediate Eligibility. This means that a member may avail of Philhealth benefits immediately upon enrollment with PhilHealth. Also, Philhealth highly encourages its members to pay their premium contribution to avoid hassle when confined in a hospital.
The premium contribution for the health insurance is P400.00 a month starting in May 2022, for a total of P4,200.00 annually. However, for house helpers whose salaries are below P5,000.00 per month, their premium contribution shall be shouldered solely by their employers. While for house helpers whose salaries are above 5,000 per month, the employer and the employee shall split the premium contribution to 50/50 per R.A. 10361 (Domestic Workers Act.)
Another policy under the UHC Act is No Balance Billing Policy. Members may avail of no balance billing when confined in a government hospital, provided that the patient was accommodated in a basic or PhilHealth ward.
Under the Point of Service program, a patient not enrolled with PhilHealth may avail of benefits when confined in a government hospital, applicable nationwide.
According to Philhealth, point of service patient refers to cases where the patient is a minor whose parent or guardian is classified as financially incapable according to the DOH classification on indigents.
The PhilHealth Konsulta package covers individual-based health services, including initial and follow-up primary care consultations, health screening and assessment, access to selected diagnostic services, and medicines.
To avail of the Konsulta Package, a patient must be a Philhealth member; must register at an accredited Konsulta provider of choice; and the patient must fill out the Konsulta Registration Form to be submitted to Philhealth.
PhilHealth members are categorized as either direct or indirect contributors.
Direct contributors are employees, individually/voluntarily paying members, group enrollment program members, lifetime members who are gainfully employed, and overseas workers. On the other hand, indirect contributors are indigents, 4Ps, persons with disabilities, SK members who are not receiving a salary, senior citizens, and point of service beneficiaries.
Declared qualified dependents are legitimate/legal spouses, children 21 years old and below, foster children, and parents who are 60 years old and above.
The UHC Act provides for automatic membership of every Filipino citizen to the National Health Insurance Program (NHIP). This means that every NHIP member shall be granted immediate eligibility for health benefits regardless of non-registration/non-membership with PhilHealth under Republic Act No. 7875 as amended by Republic Act Nos. 9241 and 10606. **Ariel John Suba
